COMPLAINT: INITIAL REPORT FORM

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W: Administration/Discrimination Log file/Grievance INITIAL REPORT form 1 COMPLAINT: INITIAL REPORT form Name of Complainant:_______________________ Location: ______________________________ Address_______________________________ Phone #: _____________ E-Mail: ________________ Date of Occurrence: ____/____/____ Date of Complaint: ___/___/___ Type of Complaint (check one): Employee Misconduct Program/Process Eligibility Discrimination Other:__________________________________ ____________________________ Program: WIA JET ES To be Filled Out by Grievance Officer Describe what took place or what caused you to make this investigation. Get all the facts, etc. Details of Complaint (include dates/times): ________________________________________ ________________________________________ _____ Name/Title of Parties Involved: Persons who can provide additional Information: Name_____________________________ Address_______________________________ Phone #: __________________________ E-Mail: _______________________________ Name_____________________________ Address_______________________________ Phone #: __________________________ E-Mail: _______________________________ W: Administration/Discrimination Log file/Grievance INITIAL REPORT form 2 Specific acts, regulations or other agreements believed to be viol

W: Administration/Discrimination Log file/Grievance Initial Report Form 2 Specific acts, regulations or other agreements believed to be violated:

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